Repeated vigorous movements can damage baby's neurons

Dr Cheang (centre) showing what a brain damage in SBS cases look like. Looking on are (left) neonatologist Dr Cheong Hon Kin and child neurologist Dr Alex Khoo Peng Chuan.

PARENTS are advised not to use a cradle, especially the electrical ones, to prevent Shaken Baby Syndrome (SBS).

Raja Permaisuri Bainun Hospital’s neurosurgery department head and consultant Dr Cheang Chee Keong said although no studies showed that repeated use of cradles were among the causes of the syndrome, such action could result in damage to the neurons.

Dr Cheang said he would always advise parents against the use of a cradle due to the acceleration and deceleration process that could cause the “shearing and tearing” effect to the brain.

He said depending on the speed of the cradle, the back and forth swinging process was good enough to cause damage to the brain.

“The ‘shearing and tearing’ effect between the tissues of the white matter and grey matter of the brain communicates with one another, and therefore during such injuries it can cause obvious damage to the intelligence quotient (IQ) and cognitive functions.

“In babies, their brain is floating and during acceleration, the brain goes back and hits the skull, and during deceleration the brain goes forward. Using a cradle in my personal opinion is a no-no despite no proof stating that it can cause SBS, but in the long run it can induce damage to the neurons,” he said during an interview at his office at the hospital recently.

Dr Cheang admitted that majority of the SBS cases that happened in the country were due to the baby being shaken vigorously using bare hands, but cradle swinging could be one of the causes, too.

He explained that SBS mainly occurs when an abuser violently shakes an infant or small child, creating whiplash motion that causes injury.

He said this form of inflicted head trauma could be caused by direct blows to the head, dropping, throwing or vigorously shaking a child.

The perpetrators in such cases, according to him, are most often parents or caregivers.

“Common triggers are frustration or stress when the child is crying non-stop.

“In some cases, excuses were given that the baby fell from the cradle, some said the baby fell from the hands of the caregiver, but when we look at the scans, old concussions are seen and we know that the stories told are not true.

“For the chronic cases, it is usually happening for a long time and when suddenly their child is ill, he or she gets seizures, retina haemorrhage or becomes unconscious. Only then do the parents rush them to the doctors.

Dr Cheang showing the difference between a damaged retina (left) and a normal retina.

“As for the acute cases, it can happen immediately after the baby is shaken because the shearing force is enough to damage the brain,” he added.

Dr Cheang said that he has had a few cases where everyone from the parents to the caregivers denied shaking the baby and pointed fingers at the cradle, but these particular injuries showed that the force of the swinging was not huge enough to cause such a bad damage.

He reminisced about a case of a child that came in with acute brain injuries due to SBS and in the operation theatre when the skull was opened up, the brain was double its size.

“Due to the brain pressure that was high, the team of doctors could not even close the skin back,” he said, adding that the infant did not make it due to the severe injuries.

He said in chronic cases, the blood clot could be removed, but usually in acute cases, it was difficult to save a child due to the swelling of the brain.

Dr Cheang said parents should choose their caregivers properly, because some of them are unable to cope with too many babies at one go.

“Patience is required to take care of a baby. Both caregivers and anxious young parents need lots of patience especially when a newborn is crying constantly.

“All forms of child abuse is bad. Broken bones can be mended but brain damage is permanent,” he said.

Giving an in-depth explanation on SBS and how it occurs, Dr Cheang said the brain had multiple components.

He said the brain cells were the ones known as the grey matter and white matter, and when a child moves the head and everything inside follows.

“When the movement comes to an abrupt stop or reversed, the grey matter which is heavier and the white matter being lighter move at a different velocity.

“When SBS happens, we call it the shearing and tearing effect, which causes damage to the cells between the junction of both matters,” he added.

Dr Cheang said the blood supply comes from the arteries that flow into the brain cells and forms the main venous plexus located at the centre of the brain.

He said in order to reach the venous plexus, there are very small bridging veins and when babies are shaken, their brain floats causing small vessels to tear.

He said over time, the bleed would accumulate as the tearing of the veins occur and also cause damage to both the grey and white matter junctions, resulting in a loss of cognitive functions.

“Babies’ veins are really tiny, we are talking about less than a millimeter, and because veins are paper thin, they can be easily damaged.

“When there is a retina haemorrhage and bleed in the brain, it is almost confirmed that it is due to SBS,” he added.

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Family & Community , SBS


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